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Special Communication |

Improving the Quality of Medical Care Building Bridges Among Professional Pride, Payer Profit, and Patient Satisfaction

Richard Grol, PhD
JAMA. 2001;286(20):2578-2585. doi:10.1001/jama.286.20.2578.
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Physicians today are confronted with increasing demand to ensure and improve care of their patients. A variety of approaches claim to provide solutions to the problems of health care delivery. These approaches represent different perspectives on optimal care and the best method for improving care. By summarizing recent reviews and debates in this field, this article critically reflects on the value of some of the approaches that have gained popularity during the last decades: evidence-based medicine and clinical practice guidelines, professional development, assessment and accountability, patient empowerment, and total quality management. Evidence regarding the impact and feasibility of the various approaches is mixed or simply lacking. In particular, the health care community lacks an understanding of which approaches are most appropriate for what types of improvement in what settings and of the determinants of successful performance change. Given the complexity of improvement and change in patient care, it is not realistic to expect that one approach can solve all the problems in health care delivery. None of the popular models for improving clinical performance appear to be superior. Therefore, bridges must be built and models must be integrated to be truly effective.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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